Tuesday, February 27, 2007

Alas and alack, another supposed cholesterol reducing supplement bites the dust! This time, a double-blind, placebo-controlled study revealed that GARLIC has absolutely no effect on LDL or HDL cholesterol nor triglycerides. See the full text at Archives of Internal Medicine 2007; 167:346-353 or view the abstract by CLICKING HERE (these may require free member registration)

On the lighter-side, I gotta say this had to be one of the most enjoyable studies to participate in. In order to keep the study blind, volunteers all ate daily gourmet sandwiches in addition to taking supplements in order to mask who was receiving natural garlic (via the sandwich) and who was receiving the active ingredients in pill form. Which brings me to the question of the week, "What the heck did they use as a placebo in place of raw garlic in the sandwiches?!"

The researchers were quick to point out that while garlic is useless for lowering LDL cholesterol (as originally thought), it does not mean it does not have some other unknown effect on atherosclerosis. That is scientific CYA-speak for "it's about as effective as eating dirt." Garlic is a healthy food to be sure, it just won't lower your cholesterol.

Dr. Gardner, the head researcher put it best, "You just can't go out and have an Egg McMuffin for breakfast, a Big Mac for lunch, and a clove of garlic later and think you're okay. That's not the way it works. I really hope the take-home message from this is, if you're going to use garlic, use it in humus on whole-wheat bread, or in an Asian stir-fry full of vegetables, all power to you. That's where garlic is really good for you: do that."

Sunday, February 18, 2007

I was recently reminded of the the outrageous actions of one Dr. Chae Hyun Moon. Dr. Moon was the former Director of Cardiology at Redding Medical Center where he was the subject of an FBI investigation in 2002 for performing hundreds of unnecessary heart procedures including open heart bypass surgery. Redding is owned by what once was the second largest for profit hospital chain, Tenet Healthcare Corporation.

Moon often lied to patients after routine tests telling them that they needed immediate surgery or face a quick and certain death. Had it not been for one lucky priest who was intercepted on his way to heart surgery by an honest doctor that read his charts, Moon might still be practicing today. Moon once bragged he did 1900 procedures in ONE YEAR! Do the math, that's over 5 per day! It is no wonder that among the less serious charges against him were failure to provide adequate post-surgical care and patient medical records.

The most chilling aspect of this case is that Moon's butchery dated back well over a decade. Local doctors were afraid to fight this respected "quack" and the profit-driven monster behind Tenet Healthcare. A rival hospital finally required that all their patients sent to Moon must be monitored by their own Cath Lab Director in 1996. They knew what was going on and opted to cover their own asses while allowing Moon to continue to malpractice on other hospital's patients! Unbelieveably, these restrictions were eased after Moon sued the hospital - and I kid you not - for restraint of trade!!! The Medical Board of California did not get around to suspending Moon for nine months after the FBI raid on Redding Medical Center.

In the end, Moon faced no criminal prosecutions and finally had to give up practicing only because he was unable to secure medical malpractice insurance. It is a sad day when our last and only line of defense is the INSURANCE COMPANIES! If you or I started cutting into people for no good reason we would be labeled perverts, sadists, even murderers and would would be spending our retirement behind bars. Can I possibly impress upon everyone how imperative it is to take responsibility for your own health and to seek multiple opinions?

Maddeningly, this "healthcare holocaust" was no wake-up call to the field of interventional cardiology. When did a medical degree become a license to destroy lives for profit? Even as I write this blog there are young cardiologists out there exclaiming, "I have to find a way to do more procedures!" That, my friends, is an actual quote and it makes my skin crawl. BEWARE: The butchers are still lurking. Don't be led like a sheep to slaughter. You need not be the next victim.

Tuesday, February 13, 2007

Sometimes the report from the heart health front lines just makes ya just want to grin from ear to ear. EPIC, a major multi-center study (519,978 participants in 23 centers located in 10 European countries) was the first major study to establish the value of a Mediterranean diet (including wine) in reducing overall mortality. A recent EPIC cohort study (a sub-group with no previous history of heart disease) followed 23,681 individuals for over 6 years and found that working men who take a mid-day "siesta" had a 37% reduction in fatal coronary events compared to those who did not take naps. Sorry ladies, but too few women died under ANY circumstances to make as strong of a statistical correlation between nap-taking and heart health (but there was a little)!

1. What are carotenoids? They are natures pigments and are indeed powerful antioxidants. For example, it is the much hyped carotenoid "lycopene" that makes tomatoes red. They also makes carrots orange (hence the name, etc., etc.). But there is a wide spectrum of carotenoids each with a different color from pale yellow to dark red. Bottomline, there are tons of them and they all emit slightly different spectral signatures. Remember back to your last physics course. Color "happens" because when electromagnetic energy (light) strikes matter it absorbs some frequencies and reflects/scatters others. You know, light energy strikes the electron cloud, momentarily elevates electrons to a higher energy level, they fall back to their normal state and release a photon of a particular energy level (i.e. frequency) that corresponds to the light you "see." Simple, right?! This brief review is background for point #2.

2. By what method does this device make the measurement? If you dig deep enough (they don't really say upfront - for good reason) you will find they claim to use Raman Spectroscopy, a method of determining the presence of certain compounds by detecting scattered laser light of certain frequencies. But, the studies they cite all report how this technique is used to measure carotenoid compounds in the macula of the human EYE (primarily the carotenoid "lutein" which has been shown to slow macular degeneration). For their scanner to work properly it would presuppose the human hand absorbs carotenoids uniformly and that HAND skin is as similar from person to person and as undisturbed by environmental factors as the macula on the retina of your eyes. Let's see, the macula is inside the eyeball surrounded and bathed by an aqueous solution and the hand is - well - God knows where YOUR hand has been! So, I think NOT you bunch of pseudo-science scam artists. Their own data shows that carotenoid concentrations per unit measurement by their device change by as much as 50% based on the population scanned! So much for accuracy!

3. What is the value of the measurement? Well, again supposedly, it is to tell you whether or not you are deficient in antioxidants. But even they admit the the device ONLY measures carotenoids. Recall point #1. Do they purport to measure every last one of the multitude of carotenoids?! There are also literally dozens of other antioxidants in the human body. Even if you were "a quart low" on carotenoids, it does not mean you are completely antioxidant deficient. And, exactly what level is considered deficient? That's a good question too. But, since the device is calibrated in the field, an unscrupulous operator can set it to register ANY level as deficient, which leads us to our final and most damning question.

4. What does Pharmanex REALLY sell? Why, antioxidant supplements, of course. What better way to bump up sales than to come up with some fancy Rube Goldberg contraption that tells you that you need their product to be healthy. They literally brag about the income opportunities for selling supplements and consumables for their "scanner."

Neat trick, huh?! This is not the first nor the last group of sheisters to pull this type of medical hoax. I have no doubt that this device measures SOME level of carotenoids in the hand, but given the variable nature of the tested substance and medium (your freakin' hand!) is it accurate? Is even an accurate measurement of carotenoids a proper assessment of health? Ahhh, probably NOT! So, if your doc, supplement clerk, or nutritionist wants to "biophotonically" test you just tell them to shove a photon torpedo where the sun don't shine!

I have added another one of my favorite web resources to my list in the right column, Lipids Online. Check their extensive slide library for high-brow multimedia discussions of lipid management in the treatment of heart disease. You will either be fascinated or bored by the tech-talk but you will see what the movers and shakers of heart research are broadcasting at all those medical conventions you hear about.

WARNING: Keep in mind this is the voice of traditional medicine. They will often be slightly behind the curve and pushing a lot of drugs and procedures. There are useful gems especially about existing technology and theories but remember the source and keep your bullshit filters engaged!

"Can I buy you a drink?" Man, I haven't used that line in . . . well . . . decades! More properly today's comment generated question (thanks David) is "SHOULD I buy MYSELF a drink?" Wow, what a loaded (pun intended) question.

The Good

It is generally accepted that 'moderate' drinking, 1-2 drinks per day for men and 1 drink per day for women, results in better cardiac outcomes over those who have no alcohol intake at all. One drink is considered 12oz. of beer, 4oz. of wine, or 1oz. of spirits (100 proof). Each of these amounts delivers about 12 to 14 grams of ethanol, the active ingredient in these beverages. Here is what the evidence seems to show on the positive side.

1. The best known effect is an increase of up to 18% in good cholesterol (HDL) and the effect has been shown to be dose dependent (See THIS STUDY).

2. Like aspirin, alcohol (and compounds found in alcohol like resveratrol in wines) reduce platelet aggregation (clotting). After all what is a heart attack but the formation of a clot?! In fact, the American Heart Association recommends AGAINST drinking alcohol if you are on an aspirin regimen (Yikes, what about fish oil on top of that? I should be hemorrhaging any minute now!)

3. Red wines contain flavonoids that act as anti-oxidants. Of course, the role of anti-oxidants in heart disease is in question.

4. Multiples studies over 10 to 15 years in duration with tens of thousands of participants show a 20% to 40% reduction in heart disease related death in moderate drinkers versus non-drinkers.

5. Yes, there are a few other non-heart related benefits. But, that is for some other blog.

The Bad

Now the bad news (as if you didn't know). I won't even bore you with a point by point discussion of the potential physical and psychological damage due to alcohol abuse (high blood pressure, diabetes, cardiomyopathy, liver disease, cancer, depression/suicide, birth defects, traffic fatalities, yada, yada, yada). Two more things.

1. A drink per day means just that. You cannot "save up" your drinking for the weekend.

2. If you drink, supplement your diet with about 600mcg of folic acid (Vitamin B-9). Alcohol blocks and and inhibits folic acid. This is especially crucial to mitigate the increased risk of breast cancer from alcohol.

The Ugly

Let' face it, like dynamite, alcohol is powerful stuff with the potential for both good and bad. The problem is stopping after one. ONE DRINK!? You gotta be kidding me. I can knock off a whole bottle of red wine in an evening with no problem. And, let's not kid ourselves. You can achieve EVERY ONE of the benefits of alcohol, without partaking of a single drop, via diet, exercise, supplements, and other medications.

Lord knows, I am not a temperance zealot. I drink moderately (well, OK, sometimes not so moderately). But, alcohol is a drug. Using it is tantamount to self-medication without a doctor's prescription. But, it is legal and anyone who drinks knows full well the (temporary) social and physical pleasure it can provide. The trick is to drink responsibly. Here is a trick I use from time to time just to keep myself honest. Try abstaining completely for a week every so often. If you cannot, at least be smart enough to get help! AND FOR GOD'S SAKE DON'T DRINK AND DRIVE! Now be careful out there.

Wednesday, February 7, 2007

This is a blog I have been meaning to write for a while. We all want a cure for heart disease, but would we know one if we saw it? Exactly what does it mean to us as heart disease sufferers to be cured? Here is a "shoot from the hip" debate I have been having with myself.

First of all, you can't cure everybody. Hell, even today we can't cure ALL infections and people still die from them. So what percentage of heart disease sufferers must be "cured" before we say we have a cure. My guess is 95% would be a good start. I want to have a 95% cure rate before I acknowledge a "cure" has been found.

Next, what does it mean to be "cured?" How do we measure it? Does it mean a halt to growing heart disease, an active reversal, or a complete remission (zero heart score scan). Do we measure it by heart scan score or some other means. Right now it appears as though zero calcium score growth or reversal significantly reduces heart attack.

A cure cannot necessarily mean no heart attacks because there are other mechanisms at work such as vasospasm. Also, we all get old and die of something. Sooner or later our genes fail us and systems such as our arteries begin to fail or become frail even with perfect lipids. Can we really say a "cure" is no good because it will not prevent all genetic failures? If you have a heart attack at 90 does it mean the "cure" failed. For me, I would have no problem anointing a "cure" if it keeps me alive one year longer than the average lifespan. You have to die of something sooner or later (Yeah, that sucks but what ya gonna do?).

Finally, does the "cure" have to be durable. Antibiotics are a cure for most infections yet we all keep getting them and the effects, though minor, can be cumulative. If I take the "cure" and it stops my heart disease, but then I quit exercising and snack on "chicken fried bacon" or resume smoking and have a heart attack is that a failure of the cure. Does a true "cure" have to be effective no matter how poorly I discipline myself?

So, here is my definition of a "cure" for heart disease.

1. It stops or reverses the accumulation of plaque (as measured by calcium score) in 95% of otherwise healthy individuals with no unusual genetic defects.

2. I must live beyond the average life expectancy before dying of a heart attack.

3. The cure need not be durable (i.e. if I stop taking it heart disease can return) but must remain effective while I am taking it.

4. The cure does not need to be a single "magic bullet" or pill but can be any set of products and disciplines that achieves goals 1,2, and 3.

Monday, February 5, 2007

The subject of using plant sterols and stanols as a natural substitute for ezetimibe (Zetia) was brought up in one of the comments. Plant sterols and stanols are both natural substances that work much like the prescription drug ezetimibe in that they block the absorption of dietary cholesterol in the intestine (as opposed to statins which stimulate LDL cholesterol removal in the liver).

Both sterols and stanols work equally well although not as powerfully as ezetimibe. Of the two, plant stanols are considered superior to sterols for two reasons. First, one study found that sterols can lose effectiveness over time and stanols do not. Second, stanols are not absorbed by the body so there is little danger of toxic effects due to long-term build-up.

Stanols also do not occur as frequently in nature and appear to be more expensive to produce. It is no co-incidence then, that stanol bearing products like Benecol are more expensive than other similar products which contain sterols. In fact, I do not know of another major brand that uses stanols over sterols but Benecol.

I love this stuff primarily because I have deprived myself of so many foods I used to enjoy and can now eat a tasty "fat" without having worry that it is killing me. I am practically giddy that I can eat a piece of toast or add something to dry popcorn that is actually good for me.

If you are a heart health super-geek like myself, you may want to to check out the databases available at the National Library of Medicine. A list in the right column of the home page offers an exhaustive searchable list of research publication that are certain to either fascinate you or put you to sleep. The Medline database is organized by topic and is geared for the lay person while the super-geek PubMed database provides tutorials on how to use its sophisticated search tools. See the my personal research link list in the right column.

The L-Carnitine Conundrum strikes back! Looks like inquiring minds want more on this enigmatic supplement.

What is Carnitine?

Carnitine is a amino acid derivative that transports long-chain fatty acids across the inner mitochondrial membranes to form adenosine triphosphate or ATP, the basis for virtually all cell energy. The bottom-line is you need this stuff to survive. Click Here for more.

What is with the "L" - why not just call it Carnitine?

Good question. Carnitine is a stereoisomer which means it exists as two atomically identical compounds that are mirror images. For example, look at your hands. They are identical in composition and structure yet are "arranged" differently (left-handed and right-handed). The "L" stands for "levo" and denotes that this particular form of the carnitine molecule "twists" to the left. There is also "D-Carnitine." The "D" stands for "dextro" and means this form twists to the right. Although they are atomically equivalent the twist makes them behave differently. Suffice to say that only L-Carnitine provides biochemically available carnitine to the body.

What is with all the different preparations?

Here is the quick list.

L-Carnitine: Sometimes (though incorrectly) called just Carnitine, this is what your body needs. Click Here for more.

Acetyl L-Carnitine (ALCAR): The action of ALCAR is similar to L-carnitine. There is speculation that it is better absorbed than L-carnitine, but this has not yet been definitively established. Click Here for more

Propionyl L-Carnitine (PLC): It seems some in the research community have a dubious preference for PLC because of a report that it has a higher affinity for the plasma membrane transport system, being more lipophilic (disolvable in fats) and penetrating better than L-carnitine (Lango, R., Smolenski, R. T., Narkiewicz, M., Suchorzewska, J., and Lysiak-Szydlowska, W. (2001) Cardiovasc. Res. 51, 21-29). I cannot find a study with enough power to statistically substantiate whether this is true or not.

Does it work?Well, yes and no. If you are carnitine deficient, this supplement works wonders on numerous levels (see previous blog). Deficiency can occur if you are undergoing dialysis, on a strict diet that limits sources of natural L-Carnitine, or have some sort of genetic deficiency. There are several heart related conditions that, when severe, seem to benefit from L-Carnitine supplementation. A good example is Peripheral Artery Disease (PAD). Severe sufferers seems to benefit substantially but the effect tapers off as the severity of the disease tapers off. In one prominent study, athletes gained no advantage from L-Carnitine.

The bottom-line seems to be that L-Carnitine can be useful if you have a carnitine related problem but adds no additional beneficial effect if you are healthy. It also has few toxicity or adverse reaction problems so is not likely to be dangerous. However, note this supplement is banned in Canada and is available only by prescription as it is considered a drug there.

Could L-Carnitine help you? Maybe, I tried it (to no avail). Just be objective. Don't believe everything you read in health magazine supplement ads. Ask yourself, "Do I feel better. Did my lipids improve? Did my calcium score go down?" Remember, we are all different. What works for some will not work for others. Unfortunately, there isn't enough evidence to say, absent disease or deficiency, that it will PROBABLY help you.

Sunday, February 4, 2007

A number of people have asked about L-Carnitine. Here is what I know to date. Carnitines come in a variety of compounds that are commercially available as L-Carnitine, Acetyl L-Carnitine, Propionyl L- Carnitine (they are all pricey). Although I have found no large scale studies there are several small scale studies at respected institutions where carnitines have been effective for such things as cancer related fatigue, male age related dysfunctions (e.g. fatigue and erectile dysfunction), alzheimers, diabetic neuropathy, and a host of other maladies. I took L-Carnitine for an extended period for its reputed ability (again small studies) to reduce lipoprotein(a) by 8-10%. It did not work for me but again, I am a statistical population of one and no inferences can be made from my personal experience.

Wikipedia has a decent technical description of carnitines here. There is also an old Medscape Article that pretty much puts carnitine in the "so-so" class of nutraceuticals. The evidence is positive but extremely weak for heart benefits. It is fairly benign in terms of side effects and toxicity at levels at or below 3 grams per day based on the reports I have seen.

Hats off to Neil for posting the link to this YouTube video that made my arteries harden just by watching. Chicken fried bacon? You gotta be kidding me! And people wonder why there is a heart disease epidemic. Check this link http://tinyurl.com/y8sqv2 and you will groan, laugh, and cry until your head (and/or heart) explodes!

Saturday, February 3, 2007

The Agency for Healthcare Research and Quality recently issued a report that placed heart drugs at the top of the prescription drug spending list at $31.7 billion annually. This outpaced the next closest therapeutic drug class (hormones at $24.5 billion) by nearly 30%! Anti-Cholesterol drugs followed close behind in 4th place at $21.5 billion. When added together, these two heart related drug classes accounted for approximately 30% of all prescription drug expenditures.

As a heart health consumer activist I am often the first to criticize the drug industry for its "profit over people" motives. For example, the subject report also lists Anti-Cholesterol drugs as having the highest average expense (more than twice the average of the lowest drug group). I buy a lot of those drugs and can confirm they cost a bundle. But, some like to claim that the pharmaceutical industry is nothing but a license to print money. Trust me, it ain't so. If it were that easy my stock portfolio would contain nothing but drug companies (I got an "A" in Investment Analysis and Portfolio Management in business school). Pfizer just took a multi-billion dollar bath on torcetrapib - a failed drug I was counting on to help me. What frightened me even more is that this colossal financial failure might scare away additional investment in other "reverse cholesterol transport" agents. That would be a travesty in my humble opinion.

The bottom-line is this, heart drugs mean big sales and profit dollars which, in turn, attracts big research and development dollars. Call me mercenary but, when my life hangs in the balance, this kind of greed is good! So, until they discover the "magic bullet" for heart disease I remain

Under which condition would I consider myself "cured" of Coronary Artery Disease (CAD)?

About This Blog

I am a numbers guy, an engineer, MBA, and for the real numbers geeks, a Six Sigma Black Belt (statistics on steroids). I am also a heart disease sufferer. It took my mother, her brother, and their father. One minute they were alive and symptom free, the next they were dead. No good-byes, just gone. So, I became a heart health activist and resolved that I will die some other way.
This blog is about my journey to save myself and others, unearthing advances and atrocities, separating hope from hype, and delivering the unvarnished truth about curing heart disease, both good and bad.
So, hold on tight. I promise you a hell of a ride!